BACKGROUND: The results of the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial showed a statistically significant 29% prostate cancer mortality reduction for the men screened in the intervention arm and a 23% negative impact on the life-years gained because of quality of life.
However, alternative prostate-specific antigen (PSA) screening strategies for the population may exist, optimizing the effects on mortality reduction, quality of life, overdiagnosis, and costs.
METHODS: Based on data of the ERSPC trial, we predicted the numbers of prostate cancers diagnosed, prostate cancer deaths averted, life-years and quality-adjusted life-years (QALY) gained, and cost-effectiveness of 68 screening strategies starting at age 55 years, with a PSA threshold of 3, using microsimulation modeling. The screening strategies varied by age to stop screening and screening interval (one to 14 years or once in a lifetime screens), and therefore number of tests.
RESULTS: Screening at short intervals of three years or less was more cost-effective than using longer intervals. Screening at ages 55 to 59 years with two-year intervals had an incremental cost-effectiveness ratio of $73000 per QALY gained and was considered optimal. With this strategy, lifetime prostate cancer mortality reduction was predicted as 13%, and 33% of the screen-detected cancers were overdiagnosed. When better quality of life for the post-treatment period could be achieved, an older age of 65 to 72 years for ending screening was obtained.
CONCLUSION: Prostate cancer screening can be cost-effective when it is limited to two or three screens between ages 55 to 59 years. Screening above age 63 years is less cost-effective because of loss of QALYs because of overdiagnosis.
Heijnsdijk EA, de Carvalho TM, Auvinen A, Zappa M, Nelen V, Kwiatkowski M2, Villers A, Páez A, Moss SM, Tammela TL, Recker F, Denis L, Carlsson SV, Wever EM, Bangma CH, Schröder FH, Roobol MJ, Hugosson J, de Koning HJ. Are you the author?
Department of Public Health and Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands; Tampere School of Health Sciences, University of Tampere, Tampere, Finland; Unit of Epidemiology, Institute for Cancer Prevention, Florence, Italy; Provinciaal Instituut voor Hygiëne, Antwerp, Belgium; Department of Urology, Kantonsspital Aarau, Aarau, Switzerland; Department of Urology, Centre Hospitalier Regional Universitaire, Lille, France; Department of Urology, Hospital de Fuenlabrada, Madrid, Spain; Centre for Cancer Prevention, Queen Mary University of London, UK; Department of Urology, Tampere University Hospital and University of Tampere, Tampere, Finland; Oncology Center, Antwerp, Belgium; Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden; Memorial Sloan-Kettering Cancer Center, Department of Surgery (Urology), New York, NY.
Reference: J Natl Cancer Inst. 2014 Dec 13;107(1):366.